Advancing military medicine education: Curriculum integration and practical training at the Defence Services Medical Academy

TriService Nursing Research Program: A critical component to support military nursing science

Our goal was to compare the demographics and discharge diagnoses between civilian and military health care systems. One year (1997) of data from the Retrospective Case Mix Adjustment System from the Military Health Services System were compared with the most recent (1994) civilian National Hospital Discharge Survey data. Military and civilian inpatient age (52.5 and 52.9 years), gender (54% and 59% female), and ethnic distributions (military: 71% white, 16% African American, 3% Asian American, 10% other; civilian: 65% white, 12% African American, 2.6% Asian American, 1.2% Native American, 18% unclassified) were similar. There were similar rank orderings of diagnosis-related groupings (Spearman's rank correlation = 0.72) and procedures performed during hospitalization (Spearman's rho = 0.74), although the military inpatients yielded a higher proportion associated with pregnancy and strenuous activity (traumatic joint disorders and hernias) than their civilian counterparts. The practice content of military and civilian inpatients appear to be more similar than different.

PurposeThis article aims to address the need for a more structured partnership between civilian and military healthcare, particularly in the context of cross-border threats in the EU. While both systems are driven by the same goal of providing high-quality healthcare services and achieving optimal patient outcomes, they operate under different national approaches and resources.Design/methodology/approachTwo recent crises are presented as examples that highlight the necessity of cooperation between civilian and military medical systems. The Covid-19 Pandemic and the Ukrainian Conflict are described based on the experience gathered by the author as a member of the NATO Centre of Excellence for Military Medicine and form the base to shape a broader perspective on the future of civil-military interaction in healthcare at the European Union level.FindingsThe ability to deliver coordinated responses during crises depend on the level of interoperability, preparation and mutual understanding. To improve synergies, a structured partnership should be established, prioritizing common standards of care and shared best practices. Integrating military and civilian healthcare pathways can be especially beneficial in situations where patients are moved from the point of injury or sickness across different military and civilian structures to receive the most appropriate treatment and rehabilitation for their conditions.Originality/valueThe relationship between military and civilian healthcare systems is often discussed at multinational level, but a clear focus is lacking concerning their shared mission, distinct functions and potential for cross-border collaboration.

: The Uniformed Services University of the Health Sciences (USHUS) is proud to offer this report of the 5th Conference on Military Medicine, A Challenge to Readiness: Maintaining Currency in Military Medical Education. These Proceedings serve as a record of the Service's Surgeons General nominees' contributions toward predicting the changes that will affect military medical practice over the next twenty to thirty years and of their recommendations rewarding the changes needed in military health care education to prepare today's students to practice in the future. The Uniformed Services University, as the nation's pre-eminent center of military medical education, is committed to ensure that its students are prepared to practice in our rapidly changing world. To this end, Dr. Val Hemming, Dean of the School of Medicine (SOM), directed that this conference be conducted and its proceedings be published. The specific focus of this conference was to identify the anticipated changes in military health care practice and the new educational objectives needed to properly prepare military health care practitioners for the next twenty to thirty years.

The article reflects the impact of the Second World War on the process of forming the military medical service of the USSR, of which Ukraine was a part at that time. It was shown how medical support was changed in different periods of the war, how military-medical education and science developed, approaches to providing medical assistance in combat conditions, system of medical-evacuation support was improved, material-technical base was developed, and sanitary transport and aviation, medical institutions were developed. Staffed in peacetime, they had insufficient staff, property and transportation for the war. No uniform principles for the provision of medical assistance for civil and military medicine were introduced, which led to differences in the treatment of the wounded. The experience gained by the medical service of the Soviet-Finnish war gave much value for military surgery. The problem of primary surgical treatment of a gunshot wound with the prohibition of suturing immediately after treatment was solved, and this principle was applied throughout the Second World War. It is proved that the Second World War gave a powerful impetus for the development of military medicine, its science, technology and education, increased staffing due to the reorganization of military medical and medical education. The bed fund increased, the logistics were improved, the fronts received sanitary regiments, and the armies - auto-sanitary companies, a system of medical and evacuation support with emergency evacuation was formed. Conducted medical events and measures returned to the ranks of the army 72.3% of wounded and 90.6% of patients. Military medicine has received invaluable combat experience, which has given a powerful impetus to national science, technology and education.

The aim of the study is to evaluate the prevalence and factors associated with opioid prescriptions to postpartum patients among TRICARE beneficiaries receiving care in the civilian health care system versus a military health care facility. We evaluated postpartum opioid prescriptions filled at discharge among patients insured by TRICARE Prime/Prime Plus using the Military Health System Data Repository between fiscal years 2010 to 2015. We included women aged 15 to 49 years old and excluded abortive pregnancy outcomes and incomplete datasets. The primary outcome investigated mode of delivery and demographics for those filling an opioid prescription. Secondary outcomes compared prevalence of filled opioid prescription at discharge for postpartum patients within civilian care and military care. Of a total of 508,258 postpartum beneficiaries, those in civilian health care were more likely to fill a discharge opioid prescription compared with those in military health care (OR 3.9, 95% CI 3.8-3.99). Cesarean deliveries occurred less frequently in military care (26%) compared with civilian care (30%), and forceps deliveries occurred more frequently in military care (1.38%) compared with civilian care (0.75%). Women identified as Asian race were least likely to fill an opioid prescription postpartum (OR 0.79, 95% CI 0.75-0.83). Women aged 15 to 19 years had a lower odds of filling an opioid prescription (OR 0.83, 95% CI 0.80-0.86). Women associated with a senior officer rank were less likely to fill an opioid prescription postpartum (OR 0.83, 95% CI 0.73-0.91), while those associated with warrant officer rank were more likely to fill an opioid prescription (OR 1.14, 95% CI 1.06-1.23). Our data indicates that women who received care in civilian facilities were more likely to fill an opioid prescription at discharge when compared with military facilities. Factors such as race and age were associated with opioid prescription at discharge. This study highlights areas for improvement for potential further studies. · Opioid prescription patterns for postpartum women may vary across the country.. · Our study indicates postpartum patients in civilian care are more likely to fill opioids postpartum.. · This study highlights a population which may have an improved opioid prescribing pattern..

This study aimed to analyze many archival published documents and contemporary testimonies at the beginning of the 18th century, which reflects little-known facts of medicine history. The creation history of military medicine in Saint Petersburg, an integral part of the military history of Russia, was presented against the background of the most important events of the Northern War against Sweden (17001721) and military reform. The role of Robert Erskine (16771718), the reformer of Russian medicine, the head of the entire military medical service of Russia since 1706, the first Russian archiater, Surgeon in Ordinary to the King, and loyal companion and friend of Peter I was carefully studied, as he played a crucial role in establishing military medicine and medical education in Russia, mainly in Saint Petersburg. R. Erskine, who had encyclopedic-level knowledge, was also the creator and head of the Kunstkamera, the first public natural science museum in Russia (1714). The report of the head of the Moscow hospital on Yauza, Doctor N.L. Bidloo, to the Holy Synod (1722) with description and analysis of the most important facts of the Russian medicine history was also studied. Detailed documents on the number of sick and wounded people in Saint Petersburg since 1708 were presented. Not only military hospitals but also medical students in the military capital of Russia before 1715, had been documented. The documentary lists of Navy doctors from Saint Petersburg and lists of medical students who stayed in Saint Petersburg at the Navy Hospital, with the indication of the salary by articles (categories) for 1710, as well as documents on the number of sick and wounded people of the ground forces for 1712 and 1713 (Russian State Archives of the Navy), were presented. The medical staff lists of the Russian army for 1711 were examined. The absence of a large specialized medical complex at Vyborg side and insufficient suitable hospitals of any medical units located in wooden barracks at other territories cannot be proof of the absence of any hospitals until 1715 or medical schools until 1733. Ignorance of the military history of Russia can lead to numerous mistakes by historians who are interested in military medicine.

Despite the positive changes in the regulation of the accordance of benefits at the federal and regional levels, this problem has not been sufficiently studied so far in the area of organizational and legal interaction between civil and military healthcare. The current order of drug supply to certain categories of citizens attached to military medical organizations results in an unjustified expenditure of resources and an increase in the burden on healthcare, which indicates the irrationality of the existing mechanisms of drug supply. In this regard, it is necessary to develop rational economic and pharmaceutical mechanisms, as a set of methods for managing and interacting the entities that determine the order of drug supply for certain categories of citizens, while optimizing the financial, information and material resources of military and civilian healthcare. Theoretical approaches to the formation of rational economic and pharmaceutical mechanisms of drug supply are presented. Rational economic and pharmaceutical mechanisms of drug supply of certain categories of citizens attached to military medical organizations have been substantiated and developed. The characteristic of integration and coordination mechanisms of interaction of military and civil health on drug supply of certain categories of citizens in a single legal space is given. As the basic mechanisms of coordination of interaction are given: information exchange; standardization; direct supervision. The results of an assessment of sound and developed rational economic and pharmaceutical mechanisms of drug supply in the areas of organizational, social and economic efficiency are presented. It is noted that the implementation of the mechanisms of drug supply in the system of preferential drug supply can contribute to the formation of a system of drug supply balanced with the available resources of the country’s population; the formation of economic and social responsibility at each level of decision-making; the optimization of transparency and controllability of financial flows; the optimization of the financial burden on the federal, regional and departmental budgets; the equal access to medicines for all categories of citizens; guaranteed drug supply to socially vulnerable groups of the population.

Ukraine's health and trauma system has been detrimentally impacted since the Russian Federation invasion in February 2022. The number and extent of injuries experienced in Ukraine because of trench warfare and high-intensity large-scale combat operations has not been seen in recent conflicts. Understanding attitudes and perceptions around the use of devices and products including MOVES (monitor, oxygen concentrator, ventilator, and suction system) and its use in the large-scale combat operation environment can inform lessons learned for improved prehospital care in Ukraine, as well as in other future conflicts. We conducted qualitative key informant interviews with military and civilian Ukrainian health care workers during the ongoing conflict using an expanded version of the Global Trauma System Evaluation Tool. We focused the analysis on identifying and understanding the capability of MOVES Micro-integrated Life Support System (SLC). Thirty-six participants were interviewed; 56% were military and 44% were civilians and representative of all NATO roles or levels of care. Sixty-one percent of participants were male. Seventy-two percent of participants were stationed in the Eastern and Northern regions. The mean age was 34.9 years. Sixty-seven percent of care providers reported using MOVES SLC and the remainder stated they wanted the device. The device was sometimes referenced as a "portable ventilator." Of other donated surgical equipment, MOVES SLC was described as "unique." A stabilization modification was suggested as a need given the ad hoc vehicles used for en-route critical care. Participants reacted positively to using MOVES SLC and the capabilities and improvements in care that MOVES SLC can provide for en-route care of critically injured patients. MOVES SLC is well regarded by Ukrainian trauma care providers. Training may be necessary to increase the quality of care when utilizing these devices, and vehicle modifications may be necessary for use given some concerns over the equipment falling during transport. There is a need to study how this equipment improves the ability of limited medical personnel to provide prolonged care for a larger number of patients with reduced medical resupply.

Current literature demonstrates a lack of discussion relative to the marketing of military health care. This is unfortunate, as marketing should be approached as a valuable tool for showing the quality of work provided by a medical facility and for improving consumer relations. The benefit is a public better educated about the military health services system and more attuned to the rationale behind various types of access and availability decisions. This article provides a marketing process usable by military hospitals and health care organizations.

Introduction: The response to the coronavirus disease 2019 pandemic in New York City (NYC) included unprecedented support from the DoD response, limited primarily to medical and public health response on domestic soil with intact infrastructure. This study seeks to identify the common perspectives, experiences, and challenges of DoD personnel participating in this historic response. Methods: This is a phenomenological qualitative study of 16 military health care providers who deployed to NYC in March 2020. This study was approved by the Institutional Review Board at the USU (No. DBS.2020.123). All participants served on either the United States Naval Ship Comfort or at the Javits Center. Semi-structured interviews were conducted exploring the participants’ experiences while deployed to NYC. These interview scripts were then independently coded by five research team members. Results: Four common themes and 12 subthemes were identified from the participants’ responses. The themes (subthemes) were lack of preparation (unfamiliar mission and inadequate resources); confusion about integration with civilian health care (widespread, dynamic situation, and NYC overwhelmed), communication challenges (overall, misunderstanding and miscommunication resulting in tension, and patient handoffs); and adaptation and success (general, military-civilian liaison service, positive experience, and military support necessity). Conclusion: This study provides unique insight into the DoD’s initial response to the coronavirus disease 2019 pandemic in NYC. Using this experiential feedback from the DoD’s pandemic responders could aid planners in improving the rapidity, effectiveness, and safety of military and civilian health care system integrations that may arise in the future.

The response to the coronavirus disease 2019 pandemic in New York City (NYC) included unprecedented support from the DoD-a response limited primarily to medical and public health response on domestic soil with intact infrastructure. This study seeks to identify the common perspectives, experiences, and challenges of DoD personnel participating in this historic response. This is a phenomenological qualitative study of 16 military health care providers who deployed to NYC in March 2020. This study was approved by the Institutional Review Board at the USU (No. DBS.2020.123). All participants served on either the United States Naval Ship Comfort or at the Javits Center. We conducted semi-structured interviews exploring the participants' experiences while deployed to NYC. These interview scripts were then independently coded by five research team members. We identified four common themes and 12 subthemes from the participants' responses. The themes (subthemes) were lack of preparation (unfamiliar mission and inadequate resources); confusion about integration with civilian health care (widespread, dynamic situation, and NYC overwhelmed), communication challenges (overall, misunderstanding and miscommunication resulting in tension, and patient handoffs); and adaptation and success (general, military-civilian liaison service, positive experience, and military support necessity). This study provides unique insight into the DoD's initial response to the coronavirus disease 2019 pandemic in NYC. Using this experiential feedback from the DoD's pandemic responders could aid planners in improving the rapidity, effectiveness, and safety of military and civilian health care system integrations that may arise in the future.

The U.S. Military has long been aware of the vital role effective leaders play in high-functioning teams. Recently, attention has also been paid to the role of followers in team success. However, despite these investigations, the leader-follower dynamic in military interprofessional health care teams (MIHTs) has yet to be studied. Although interprofessional health care teams have become a topic of increasing importance in the civilian literature, investigations of MIHTs have yet to inform that body of work. To address this gap, our research team set out to study MIHTs, specifically focusing on the ways in which team leaders and followers collaborate in MIHTs. We asked what qualities of leadership and followership support MIHT collaboration? This study was conducted using semi-structured interviews within a grounded theory methodology. Participants were purposefully sampled, representing military health care professionals who had experience working within or leading one or many MIHTs. Thirty interviews were conducted with participants representing a broad range of military health care providers and health care specialties (i.e., 11 different health professions), ranks (i.e., officers and enlisted military members), and branches of the U.S. Military (i.e., Army, Navy, and Air Force). Data were collected and analyzed in iterative cycles until thematic saturation was achieved. The subsets of data for leadership and followership were further analyzed separately, and the overlap and alignment across these two datasets were analyzed. The insights and themes developed for leadership and followership had significant overlap. Therefore, we present the study's key findings following the two central themes that participants expressed, and we include the perspectives from both leader and follower viewpoints to illustrate each premise. These themes are as follows: (1) a unique collaborative dynamic emerges when team members commit to a shared mission and a shared sense of responsibility to achieve that mission; and (2) embracing and encouraging both leader and follower roles can benefit MIHT collaboration. This study focused on ways in which team leaders and followers on MIHTs collaborate. Findings focused on qualities of leadership and followership that support MIHT's collaboration and found that MIHTs have a commitment to a shared mission and a shared sense of responsibility to achieve that mission. From this foundational position of collective responsibility to achieve a common goal, MIHTs develop ways of collaborating that enable leaders and followers to excel to include (1) understanding your role and the roles of others; (2) mutual respect; (3) flexibility; and (4) emotional safety. The study data suggest that MIHT members work along a continuum of leadership and followership, which may shift at any moment. Military interprofessional health care teams members are advised to be adaptive to these shared roles and contextual changes. We recommend that all members of MIHTs acquire leadership and followership training to enhance team performance.

Military medicine in the US was established to treat wounded and ill service members and to protect the health and well-being of our military forces at home and abroad. To accomplish these tasks, it has developed the capacity to rapidly adapt to the changing nature of war and emerging health threats; throughout our nation's history, innovations developed by military health professionals have been quickly adopted by civilian medicine and public health for the benefit of patients in the US and around the world. From the historical record and published studies, we cite notable examples of how military medicine has advanced civilian health care and public health. We also describe how military medicine research and development differs from that done in the civilian world. During the conflicts in Afghanistan and Iraq, military medicine's focused approach to performance improvement and requirements-driven research cut the case fatality rate from severe battlefield wounds in half, to the lowest level in the history of warfare. Although innovations developed by military medicine regularly inform and improve civilian health care and public health, the architects of these advances and the methods they use are often overlooked. Enhanced communication and cooperation between our nation's military and civilian health systems would promote reciprocal learning, accelerate collaborative research, and strengthen our nation's capacity to meet a growing array of health and geopolitical threats.

Back to table of contents Previous article Next article Professional NewsFull AccessDHA Director Describes Integration of Military Health Care ServicesMark MoranMark MoranSearch for more papers by this authorPublished Online:5 Jul 2017https://doi.org/10.1176/appi.pn.2017.7a12AbstractVice Adm. Raquel Bono directs an agency mandated to standardize best health care practices across military service lines and create a more globally integrated health care system. “We are strongest when we work together across service lines,” said Navy Vice Adm. Raquel Bono, director of the Defense Health Agency (DHA). “As a surgeon, I am not going to ask for a scalpel in a different way because the patient is in the Army or the Navy. Our common mission is the patient we serve, regardless of what kind of boots he or she wears.” Raquel Bono, M.D., said the military seeks the expertise of psychiatrists in the civilian sector in treating the “invisible wounds of war.”David HathcoxBono made her remarks at APA’s 2017 Annual Meeting in San Diego, where her theme was partnerships—across military service lines and, importantly, with physicians in the civilian sector.“As director of the DHA, I have the opportunity to oversee where our best practices are occurring and work to expand, integrate, and standardize those practices across the military,” Bono said. “If we do this the right way, we have a real opportunity to create a robust system serving all of our military service men and women and their families.”Bono said that the integration of health care across service lines is codified now in the most recent National Defense Authorization Act. Under the law, the mission of the DHA is to do the following: Create a more globally integrated health system, accountable as a combat support agency.Direct enterprise-wide shared services, standardizing clinical and business practices that produce better health and better care. Manage TRICARE for 9.4 million beneficiaries around the world. TRICARE is the health care program for uniformed service members and their families around the world.Deliver coordinated health care and support high-quality coordinated care in all multiservice markets.Regarding the visible wounds of battle, Bono said that the integration of the services is producing results. In the years since the wars in Afghanistan and Iraq started, the case fatality rate per battle injury has dropped. The invisible wounds have been more challenging. Bono solicited the help of psychiatrists in the civilian community to treat returning soldiers with traumatic brain injury and posttraumatic stress disorder. “We are very concerned about the suicide rate,” she said. “We are not dealing with a single, unitary phenomenon, but one that is very complex depending on the individual. We recognize that we don’t have all the answers, and we can’t do it alone. Partnering with others is going to be invaluable.” Vice Adm. Bono brings to her role a distinguished career in medicine and the military. She obtained her baccalaureate degree from the University of Texas at Austin and attended medical school at Texas Tech University. She completed a surgical internship and a general surgery residency at Naval Medical Center Portsmouth and a trauma and critical care fellowship at the Eastern Virginia Graduate School of Medicine in Norfolk. Shortly after training, Bono saw duty in Operations Desert Shield and Desert Storm as head of Casualty Receiving at Fleet Hospital 5 in Saudi Arabia from August 1990 to March 1991. Upon returning, she was stationed at Naval Medical Center Portsmouth as a surgeon in the General Surgery Department and attending surgeon at the Burn Trauma Unit at Sentara Norfolk General Hospital. Before becoming the director of the DHA, Bono served as director of the National Capital Region Medical Directorate of the DHA and as the 11th Chief of the Navy Medical Corps from September 2013 to October 2015.Bono said military and civilian health care providers share a common overarching mission and have much to offer each other. The military is prepared to reach out to the civilian sector, she said, such as when Patrick Downes and Jessica Kensky—victims of the 2013 Boston Marathon bombing—were invited to Walter Reed National Military Army Hospital in Washington, D.C., and partnered with “battle buddies” who had lost limbs in battle. Bono showed a video clip of a moving interview with Downes, who said, “We feel like we were embraced by the military family in a home that was meant for them.”Said Bono: “We have a sacred mission to care for our military service men and women and their families, but we also have a mission to share our experience and expertise with others. We hope you will share your experience and expertise with us.” ■ ISSUES NewArchived