Military Medical Corps Research Articles

The Military Medicine Leadership Life Cycle: A Model for Longitudinal Leadership Development for Staff Physicians.

Leadership development is a challenge for all health care systems. Military Medicine has unique challenges with increased frequency of physician turnover and more junior leaders taking on positions of leadership earlier in their careers. Military medical corps officers are also challenged with leading in clinical, academic, and operational settings. Effective leadership within the Military Healthcare System requires an intentional and ongoing leadership development process across the careers of military medical corps officers. This article describes the leadership lifecycle of military medical corps officers, highlighting existing leadership development opportunities and providing an example of a leadership lifecycle from junior staff to senior executive for other organizations. The article concludes with specific recommendations that will allow military medicine to continue to strengthen the leadership skills of its officers to meet ever growing challenges.

Embracing Leadership: How Junior Medical Officers Shape the Future.

Transitioning from medical residency to an operational role challenges junior medical officers as their leadership skills are put to the test. In the multifaceted role of Military Medical Corps Officers, patient care remains paramount, and effective leadership hinges on core values. From clinical competence and mentorship to modeling behavior and fostering adaptability, this article underscores the importance of leadership development for junior officers as they transition from the training centers into the operational environment. Effective junior officer leaders become force multipliers, empowering their teams and cultivating future leaders to uphold the values essential to mission success.

An Analysis of International Military Health Systems Using the Military Medical Corps Worldwide Almanac.

A number of organizations publish comparisons of civilian health systems between countries. However, the authors were unable to find a global, systematic, and contemporary analysis of military healthcare systems. Although many databases exist for comparing national healthcare systems, the only such compilation of information for military medical systems is the Military Medical Almanac. A thorough review of the Almanac was conducted to understand the quality of information provided in each country's profile and to develop a framework for comparing between countries. This information is valuable because it can facilitate collaboration and lesson sharing between nations while providing a structured source of information about a nation's military medical capabilities for internal use. Each of the 142 profiles (submitted by 132 countries) published in the Almanac were reviewed. The information provided was extracted and aggregated into a spreadsheet that covered the broader categories of country background, force demographics, beneficiary populations, administration and oversight, physical structures and capabilities, research capabilities, and culture and artifacts. An initial sample of 20 countries was evaluated to test these categories and their subsections before the rest of the submissions were reviewed. Clear definitions were revised and established for each of the 69 subcategories. Qualitative and quantitative data were compiled in the spreadsheet to enable comparisons between entries. Significant variation was found in how information was presented in country profiles and to what extent this was comparable between submissions. The most consistently provided information was in the country background, where the categories ranged from 90.15% to 100% completion across submissions. There was inconsistency in reporting of the numbers and types of healthcare workers employed within military medical services. Nearly 25% of nations reported providing medical care to family members of service members, but retirees, veterans, reservists, and law enforcement personnel were also mentioned. Some countries described organizational structures, military medical education institutions, and humanitarian operations. A few reported military medical research capabilities, though each research domain was present in 25% or less of all submissions. Interestingly, cultural identities such as emblems were present in nearly 90% of profiles, with many countries also having badges, symbols, and mottos. The Military Medical Almanac is potentially a highly valuable collection of publicly available baseline information on military medical services across the world. However, the quality of this collection is highly dependent on the submission provided by each country. It is recommended that the template for collecting information on each health system be refined, alongside an effort to increase awareness of the value of the Almanac as an opportunity to raise the international profile of each country's military medical system. This will ensure that the Almanac can better serve the international military medical community.

Leadership Lessons for a New Battalion Surgeon.

Military medical corps officers often do not have experience with line units until after residency. This case demonstrates the importance of understanding the flow of information within an operational setting. The case also highlights the challenges of advocating for patients as a young officer and physician.

TRAINING MANAGEMENT AS AN ANTECEDENT OF TRAINING TRANSFER

Present literature related to human resource development highlights that training management is a strategic human resource management policy. This issue has been viewed as a remarkable phenomenon in dynamic organizations. Recent studies mostly published in the 21st century proved that the ability of management to plan and implement training programs may produce a noteworthy effect on work related attitudes, particularly in training transfer. This study incorporates a cross-sectional design as it delivers flexibility to the researchers in incorporating the training management literature, a self-administered questionnaires and semi-structured interview to gather data from participants at a military medical corps using a purposive sampling method. They are the administrators, medical doctors, nurses and supporting staff who work in different divisions within the organization. The SmartPLS path model analysis was utilized to analyze the validity and reliability of the instrument, and thus testing the research hypotheses. The results of SmartPLS path model analysis revealed that the implementation of communication and assignment in managing training programs had led to higher employees’ motivation to transfer, while implementation of support in managing training programs had not led to higher employees’ motivation to transfer in the organizational sample. Therefore, this study further suggests that communication and assignment should be considered as a critical success factor for the training management domain, as well as external and internal obstacles should be comprehensively evaluated to maintain and achieve the training goals in an era of knowledge-based organization. Keywords: Assignment, communication, support, training management, training transfer. Cite as: Ismail, A., Foboy, N. A., Mohamad Nor, A., Abdullah, A. A., & Ismail, Y. (2019). Training management as an antecedent of training transfer. Journal of Nusantara Studies, 4(1), 136-158. http://dx.doi.org/10.24200/jonus.vol4iss1pp136-158

Repercusión de la medicina militar en la pediatría mexicana del siglo XX

The Mexican Military Medical Corps of the twentieth century: A. Started the creation of four large educational centers or Institutes of Mexican pediatrics: Children's Hospital of Mexico. National Institute of Pediatrics. National Institute of Perinatology and Institute of Mental Health. As well as multiple pediatric educational hospitals around the Mexico country such as children's of the Mexico city, the State of Mexico, Puebla and Oaxaca, among others. B. Helped in the formal education of pediatricians, subspecialists and experts of the country and Latin America. Some of their graduates made medical contributions of worldwide recognition. C. Participated actively in formal and continuing medical education at the national level. He disseminated the workshops on Pediatric, Neonatal, Trauma and Evidence-Based Medicine. D. Maintained and maintains a Pediatric Society, which actively participates in national educational events. E. The authors' proposal is to continue enriching this list of fellow military pediatricians who are protagonists in the development of Mexican pediatrics. Also, that the offer extends to civil and foreign graduates.

The impact of war on mental health: lest we forget

The often-unconscious and enduring impact of war is one of the driving forces of history. Yet these terrible costs and the lessons learned by psychiatry tend to be forgotten (1). At a time when many nations are remembering the legacy of World War I, the greatest military conflagration in history, it is timely to reflect on what has been learnt about the impacts of war on mental health. Ironically, it is only since the inclusion of post-traumatic stress disorder (PTSD) in the DSM-III in 1980 (2) that the field of traumatic stress has blossomed and been subsequently underpinned by a major body of neuroscience and clinical research. Despite the slow development of interest into the long-term consequences of the traumatic stress of war, many of the developments in mental health care in the 20th century emerged from the innovations demanded by the need to deal more effectively with the flood of mental casualties amongst the combatants of World Wars I and II. The model of community psychiatry was adapted from the model of forward psychiatry developed by the military to deal with acute combat stress reactions; this model was underpinned by the principles of the provision of early treatment close to the battle front with the expectancy of recovery and return to service (1). Crisis intervention, group therapy and therapeutic communities were innovations that evolved out of the military medical corps (1). However, psychiatrists who served in the military were often conflicted by powerful and potentially competing value systems concerning whether their primary responsibility was to the soldier or to the war effort (3). The prevailing attitudes would tend to indicate that individuals’ interests often lost out – the veteran who broke down in battle was generally stigmatized. The diagnoses promulgated by the profession, such as compensation neurosis, lack of moral fibre and inadequate personality reflected how the problem was seen to be caused by moral weakness and vulnerability (4). In this characterization, the causal role of the horrors of combat were minimized by psychiatry, in contrast to compensation seeking and vulnerability.

Analysis of Evacuations From Areas of Operation to the Spanish Role 4 Medical Treatment Facility (2008–2013)

Since 1987, the Spanish Armed Forces have deployed their troops in a multitude of conflicts and natural disasters worldwide. The Spanish Military Medical Corps has the ability to deploy Role 1, Role 2, and one Role 3 medical treatment facilities. It also has a Role 4 in operation, the "Gómez Ulla" Central Hospital of Defense, in Madrid. The aim of this study is to describe the type of Spanish casualties evacuated from different areas of operation to the Role 4 from 2008 to 2013. A retrospective, cross-sectional study was performed on a sample of 232 patients. Among these, 211 (91%) were noncombat casualties: 126 because of illness, 53 because of an accident, and 32 because of sports injuries. The remaining 21 (9%) were combat casualties: 11 from improvised explosive devices and 10 from gunfire. Afghanistan, followed by Lebanon, is the operational area where most evacuees originate. The authors consider it essential that the Spanish Armed Forces rely on a Role 4 medical treatment facility as part of their medical support to international operations.

Case Report: Military Subcultural Competency

The military is comprised of numerous subcultures. These subcultures can dramatically impact perceptions of illness and care. Although efforts are currently underway to improve the military cultural competence of all health care providers, efforts to improve the subcultural competence of military providers require attention. Military providers, although part of the military culture, may not appreciate their patients' military subculture or be aware of the impact their own subculture plays on the encounter. To illustrate potential difficulties, a case is described where limited military subcultural competence disrupted care. As the military medical corps continues to integrate across service lines, this case underscores the importance of training military physicians to assess the influence of a service member's specific military subculture.

The Senior Visiting Surgeons program

Abstract : The use of civilian expertise to assist the military medical corps during times of conflict is not a new concept. Perhaps, one of the most noted examples was the service of Edward D. Churchill, MD, who volunteered to serve as the chief surgical consultant in the North African and Mediterranean theaters during World War II. A colonel in the US Army, Dr. Churchill followed his deployed surgical unit from Harvard Medical School into the war zone, making major contributions to the care of the wounded, most notably in advocating for the use of whole blood for resuscitation. In addition to Churchill and DeBakey, other surgical giants who contributed to combat care during World War II included Loyal Davis, Fred Rankin, Isidor Ravdin, Robert Zollinger, Ben Eiseman, and J. Englebert Dunphy (former chief of surgery at the University of California, San Francisco). For a more in-depth review of the contributions of Dr. Churchill and others, interested readers are referred to the excellent article authored by Cannon et al. The war that has engaged US troops for the past 10 years in Iraq and Afghanistan is unique in American history. This prolonged war has been fought with an all-volunteer military service, including the members of the medical corps. A portion of the surgeons in theater are recent residency graduates and thus relatively inexperienced in trauma surgery. Other deployed surgeons may be reservists in the Army, Navy, or Air Force Medical Corps who have been deployed multiple times from their private or academic practices. Modern technology has brought the war into our living rooms and onto our computer screens, giving civilians a unique look at battlefield injuries. These considerations as well as many others culminated in the development of the Senior Visiting Surgeons (SVS) program composed primarily of civilian trauma surgeons.

Teleradiology: case series and experience acquired in the military field

Our aim was to evaluate the peculiarities of military teleradiology on the basis of the large case series collected between January 2006 and December 2010. We analysed all radiological teleconsultations/telediagnoses requested by theatres of operations: Kosovo, Iraq, Chad, warships Etna (Indian Ocean) and Cavour (earthquake in Haiti), for a total of 1,132 cases. As part of the case series collected in Kosovo (n=827), we evaluated the entire sample of patients transferred to the Celio Military Hospital in Rome following a teleradiological diagnosis (27 examinations analysed). A total of 1,132 radiological examinations were requested (704 military and 428 civilians). Comparison between teleradiology diagnoses and diagnoses made after patient transfer showed almost perfect concordance based on Cohen's Kappa (κ) statistic (92.59% identical diagnoses), with only a small minority of false positive results (two cases, 7.4%). The use of teleradiology by the Military Medical Corps helped attain an accurate diagnosis in almost all cases, significantly reducing diagnostic errors and limiting transfers from theatres of operation to cases genuinely necessitating transfer.

Combat surgeons before, during, and after war: the legacy of Loyal Davis

By 1942, Loyal Davis had firmly established himself as a preeminent civilian neurosurgeon. With military operations rapidly escalating, he was recruited to serve in the European Theater of Operations as a consultant to the Surgeon General. Davis brought tremendous experience, insight, and leadership to this position; however, he found the military system in which he was suddenly immersed inefficient and impassive. His requests for even basic equipment became mired in endless bureaucracy even as his communiqués to the Chief Surgeon in the European Theater and to the Surgeon General's staff in Washington seemed to fall short of their intended recipients. Then, when he attempted to vent his frustrations to his academic colleagues, he was nearly court-martialed. Notwithstanding, Davis became the first to formally recognize high-altitude frostbite and also developed protective headgear for airmen, and later in his service, he joined a contingent of senior medical leaders who visited the Soviet Union to study their system of combat casualty care. Subsequent to his service on active duty, Davis returned to his academic practice at Northwestern where he used his position as editor of Surgery, Gynecology, and Obstetrics to advocate for change within the military medical corps. Others like Davis have contributed greatly to the advancement of combat casualty care both during active service and long after their time in uniform. This paper examines the lessons from Davis's experiences as a military neurosurgeon and his continued advocacy for change in the medical corps along with additional recent examples of change effected by former military surgeons. For those currently serving, these lessons illustrate the value of contributing wherever a need is recognized, and for those who have served in the past, they demonstrate the importance of having a continued voice with junior combat surgeons and the military leadership.

Edward D. Churchill as a Combat Consultant

In World War II, Edward D. Churchill volunteered as a combat consultant. In this role, he mentored many junior surgeons and challenged the Army leadership to treat hemorrhagic shock with blood rather than plasma. These lessons have continued relevance for today's Senior Visiting Surgeons and our military medical corps.

The sword and the scalpel--the osteopathic 'war' to enter the Military Medical Corps: 1916-1966.

This article examines the 50-year struggle of osteopathic physicians to gain entry into the US Military Medical Corps on the same basis as allopathic physicians. The author explores various arguments put forth by both physician groups, as well as those arguments presented by the respective surgeons general and relevant government officials.

Desert Storm: Wounded Iraqi War Prisoners Keep US Physicians Busy

MORE THAN 2000 wounded Iraqi prisoners of war have been treated by US military physicians since the cease fire order in Operation Desert Storm. Many of the more than 3100 physicians of the US Air Force, Army, and Navy full-time and reserve military medical corps and the US Department of Transportation's Coast Guard, of course, now have returned from the Persian Gulf area. But some physicians still are in the Gulf region in support of the remaining US forces. A number of these US military physicians have been caring for the wounded Iraqi prisoners, according to Enrique Mendez, Jr, MD, assistant secretary of defense for health affairs. These patients are among the last of thousands of Iraqi prisoners of war who are being repatriated. The US physicians treating them of course are gaining additional experience in caring for war wounds. And the Iraqis, some of them veterans of the 8-year