Military Medical Students Research Articles

What Military Applicants Value When Choosing a Residency in Gynecologic Surgery and Obstetrics.

Military medical students participate in a separate residency match program, distinct from their civilian counterparts. There is limited information regarding factors that applicants find important when selecting a residency program in Gynecologic Surgery and Obstetrics (GSO). We aimed to identify factors that influence applicant program selection. A voluntary, anonymous, 45-question survey was distributed to military candidates pursuing GSO residency training in the fall of 2023. Participants were asked to rate the factors they considered most important when ranking residency programs. Thirty-seven of the sixty (61.7%) applicants completed the survey. The culture of the residency program was deemed "important" by most participants (94.6%), followed by surgical volume (70.3%) and obstetric volume (70.3%). When asked to rank selection factors, the culture of the residency program, geographic location, and surgical volume were among the top 5 influential factors for the majority of applicants. Participants considered the following factors "not important": Salary (military pay versus civilian salary) (43.2%), research opportunities (32.4%), and availability of abortion training (21.6%). Most military applicants (62.2%) stated that abortion restrictions would not affect program selection, while 37.8% reported that this would affect their rankings. Gynecologic Surgery and Obstetrics military applicants deemed the residency program's culture, surgical volume, and obstetrical volume to be the most important factors impacting residency program selection. Residency programs can use these findings to promote program strengths, improve program shortfalls, and guide applicant recruitment.

Stress and resilience among military medical students completing a high-fidelity military medical simulation

Background High-fidelity medical simulations can help students successfully navigate the stressors of medical training and practice. Because sufficiently high stress levels can interfere with learning, the balance of stress and resilience factors during simulation training should be carefully curated. However, student experiences of stress and resilience during high-fidelity simulations are seldom well characterized, especially in military medical training. With this in mind, the authors investigated students’ lived experiences of stress and resilience during a well-established high-fidelity simulation at a military medical school. Methods Fourth-year active-duty military medical students (n = 23) from the United States Air Force, Army, and Navy who were attending Operation Bushmaster – a 5-day, high-fidelity military medical simulation – were interviewed during and after the simulation. Data were analyzed via a hermeneutic phenomenological qualitative approach. Another 21 students reported their stress levels and trait mindfulness. Experts rated their performance at Operation Bushmaster. Results Participant narratives pointed towards major internal stressors, including chronic uncertainty and fluctuating motivation, and external stressors, such as weather and equipment-related challenges. Narratives also identified multiple factors that mitigated stress, including the use of mindfulness skills (especially mindful/tactical breathing), giving/receiving social support, shifting perspectives to centre connections between Operation Bushmaster and students’ professional purpose, and positive self-talk that gave participants permission to make mistakes and learn from them. There was a moderate positive correlation between mindfulness and performance at Operation Bushmaster. Conclusions These stress and resilience factors are critical leverage points for educators seeking to optimize learning during Operation Bushmaster and other high-fidelity simulation trainings. Future research should continue to examine how the balance of these factors impacts medical students’ immediate learning (e.g. regarding medical decision-making, skill and leadership) and longer-term ability to successfully navigate the stressors of the medical profession.

The impact of simulation-based training on medical students' whole blood transfusion abilities.

Whole blood transfusion has been found to increase the likelihood of patient survival within both military and civilian medicine contexts. However, no whole blood transfusion training curriculum currently exists within undergraduate or graduate medical education in the United States. The purpose of our study was to: (1) determine the impact of simulation-based training on medical students' abilities to conduct whole blood transfusions; and (2) determine the impact of simulation-based training on medical students' confidence in conducting whole blood transfusions. We assessed 157 third-year military medical students' ability to conduct whole blood transfusion before and after Operation Gunpowder, a 2-day high-fidelity prolonged casualty care simulation. We conducted a paired samples t-test to compare the students' pre- and post-simulation performance scores as well as self-reported confidence and stress ratings. There was a significant difference in students' scores at the beginning of the course (M = 20.469, SD 6.40675) compared to their scores at the end of the course (M = 30.361, SD = 2.10053); t(155) = -18.833, p < .001. The effect size for this analysis (d = 6.56) was large. There was a significant difference (p < .001) between the pre- and post-ratings for all self-reported confidence and stress survey items. Our results suggest that simulation-based training is an effective means of training medical students to conduct whole blood transfusiontraining in a limited resource simulated environment where blood inventories may be limited.

Contraception and abortion attitudes among military medical students: An exploratory study

ObjectivesTo investigate military medical students’ attitudes toward contraception and abortion after clerkships. Study designWe adapted a survey of civilian medical student attitudes for military students. We asked how clerkships changed perspectives and comfort discussing these topics. ResultsEighty-five (85%) of 100 respondents felt more comfortable discussing contraception and abortion after clerkships. More students changed perspectives on contraception than abortion (29% vs 17%, p = 0.043). Students noted limited exposure to abortion. ConclusionsClerkships increased comfort discussing contraception and abortion but were unlikely to change their attitudes. ImplicationsMore exposure to abortion care is needed.

Impact of a Mentorship Program to Prepare Medical Students for the Military Residency Match.

Mentorship programs have well-documented benefits to both mentees and mentors. Military medical students face unique challenges in medical school given their service-specific requirements and separate military match process. We therefore aimed to determine whether military medical students' participation in a mentorship program impacts their confidence in applying to obstetrics and gynecology (OB/GYN) residency. First, a needs assessment survey regarding the use of a mentorship program was sent to medical students, residents, fellows, and attendings. A structured mentorship program was then developed for military medical students applying to OB/GYN residency based on the survey results. Mentors were randomly paired with mentees and asked to appraise curriculum vitaes, review personal statements, and perform mock interviews. Following completion of these activities, participants were sent a post-intervention questionnaire. This project was exempt by our institution's Institutional Review Board. Our program had 56 participants, with 29 individuals completing our post-intervention survey (response rate 51.8%). After participating in the program, 92.3% of mentors stated they plan to continue a relationship with their mentee. All the mentee respondents stated they would participate in this program again. Before participating in the program, 16.7% of mentees felt "prepared" or "extremely prepared" for the match, compared to 87.6% post-intervention. Most mentee respondents (75%) reported that this program made them a more competitive applicant. Following the mentorship program, 66.7% of participants successfully matched into OB/GYN residency. This reproducible, well-received intervention can be implemented to facilitate mentoring connections regardless of geographic location. As the OB/GYN specialty develops its own application process, civilian medical schools should consider adopting similar programs to aid their students in navigating the match process.

Preparing Future Military Medical Officers to Conduct Emergency Fresh Whole Blood Transfusions in Austere Environments: A Novel Training Curriculum.

Providing resilient Damage Control Resuscitation capabilities as close to the point of injury as possible is paramount to reducing mortality and improving patient outcomes for our nation's warfighters. Emergency Fresh Whole Blood Transfusions (EFWBT) play a critical role in supporting this capability, especially in future large-scale combat operations against peer adversaries with expected large patient volumes, restrictive operating environments, and unreliable logistical supply lines. Although there are service-specific training programs for whole blood transfusion, there is currently no dedicated EFWBT training for future military medical officers. To address this gap, we developed, implemented, and evaluated a training program to enhance EFWBT proficiency in third-year military medical students at the F. Edward Hebert School of Medicine at the USU. After reviewing both the 75th Ranger Regiment Ranger O-Low Titer program and the Marine Corps' Valkyrie program, along with the relevant Joint Trauma System Clinical Practice Guidelines, we created a streamlined and abbreviated training curriculum. The training consisted of both online preparatory materials as well as a 2-hour in-person training that included didactic and experiential learning components. Participants were 165 active duty third-year medical students at USU. Participants were assessed using a pre- and post-assessment self-reported questionnaire on their confidence in the practical application and administrative oversight requirements of an EFWBT program. Participants' performance was also assessed using a pre/post knowledge assessment consisting of 10 multiple choice questions identified as critical to understanding of the academic principles of EFWBT along with the baseline questionnaire. Differences in the mean scores of the pre- and post-assessment self-reported questionnaire (increased from 2.32 to 3.95) were statistically significant (P < .001). Similarly, there was a statistically significant improvement in student test scores, with the mean score increasing by approximately 3 points or 30%. There was no significant difference in student confidence assessment or test scores based on branch of service. Students who had previously deployed did not show a statistically significant difference in scores compared to students who had not previously deployed. Our results suggest that the implementation of streamlined EFWBT training into the undergraduate medical education of future military medical officers offers an efficient way to improve their baseline proficiency in EFWBTs. Future research is needed to assess the impact of this training on real-world applications in forward-deployed environments.

A distinct immune cytokine profile is associated with morning cortisol and repeated stress.

The objective of this study was to investigate possible immune cytokine trends throughout a week-long surgical simulation mass-casualty training session in order to determine the effects of stress inoculation on the immune system. Thirty-seven military medical students participated in a hyper-realistic surgical simulation training event conducted at Strategic Operations site in San Diego, California. Salivary samples were collected every morning of the stress training exercise for 4 consecutive days. Cortisol, along with a panel of 42 immune cytokines, was measured using multiplex enzyme-linked immunosorbent assays from Eve Technologies. The determined concentrations were averaged and plotted on a scatter plot, and then points were fit to a second-order polynomial trendline of best fit to measure. The cytokines epidermal growth factor, growth-related oncogene-α, interleukin (IL)-1α, and platelet-derived growth factor-AA followed a noted pattern of cortisol decrease throughout the week. In addition, cytokines IL-27, granulocyte colony stimulating factor, IL-10, and IL-13 demonstrated a late peak, followed by a return to baseline at the conclusion of training. Finally, the cytokine monocyte chemoattractant protein-1 displayed a decline throughout the week followed by an increase on the last day of stress training. Altogether, these results help to identify important biomarkers that may help to improve long-term stress adaptation and prevent post-traumatic stress disorder following exposure to repeated stress.

Military Health Care Team Cohesion and Performance During Simulation Training.

Military health care team cohesion has been linked to improved performance during simulation training. However, there is a gap in current research regarding the processes by which teams become cohesive within simulation training. The purpose of this study was to explore how health care teams evolve during high-fidelity simulation training and the ways in which team cohesion impacts their performance. The participants in our study were fourth-year military medical students participating in a 5-day high-fidelity military medical simulation during Fall 2022.Twenty-three students volunteered to participate in our study. We interviewed each participant twice during the simulation and then transcribed each interview using an automated transcription service. Guided by the grounded theory tradition of qualitative data analysis, we used open, axial, and selective coding to analyze the interview data. Our data analysis revealed that teams went through a process of (1) struggle, (2) adaptation, (3) perceived improvement, (4) gained confidence, and (5) perceived team cohesion. Teams struggled through the various barriers to group cohesion (i.e., power dynamics, role designation and competency, and task failures and low team confidence) in order to understand their weaknesses. As teams adjusted and noticed improvement, they adapted new patterns, protocols, and standards of practice based on previous failures, improving their overall confidence. The participants perceived their teams as successful once they had progressed through these phases and ended the simulation as a cohesive unit. Our qualitative data analysis provided insight into team cohesion as it was forged by participants in real time as the simulation progressed. The results of our study can be used to promote team cohesion not only during simulation training but also within military health care professional teams in order to enhance their performance in the field.

Exploring Impostor Phenomenon During Onboarding Into a Military Medical School.

Impostor phenomenon (IP) is an experience where an individual believes that their success was because of chance or luck and was not associated with the mastery of skills. There is a gap in the literature in understanding what role, if any, onboarding (e.g., orientation weeks) into a military medical school plays into student experiences with IP. For many, onboarding serves as the first exposure to the climate, culture, and learning environment of both medical school and the military. Prevention, or early intervention, of IP may reduce potential effects on a medical trainee's confidence and competence in their profession, which may ultimately enhance health care team performance and impact patient outcomes. This study explores if and why military medical students experience IP during a 2-week-long orientation into a military medical school. The study participants were medical students at a military medical school. Researchers conducted semi-structured interviews in August 2022 to explore if and why students experienced IP and deployed the Clance IP Scale as a measure with validity evidence for ascertaining the presence and magnitude of IP. Researchers calculated total scores from the Clance IP Scale and thematically analyzed interview transcripts. Researchers interviewed 29 matriculating military medical students. Twenty-one (75%) students reported frequent or intense IP experiences on the Clance IP Scale indicating that IP was present in our study sample. Thematic analysis identified six themes that drove one's experience with IP: reevaluation of merit, individualized diversity and inclusion experiences, administrative and financial support, preconceived expectations, building relationships, and new community roles. Our identified themes provide us with a better understanding of if and why military medical students experience IP during onboarding. Our findings are also consistent with the situated learning theory, which places emphasis on the sense of belonging and may provide a unique and insightful lens through which IP can be further explored and studied, particularly at a military medical school where various identities, dynamics, and aspirations can converge simultaneously. Additionally, our findings suggest that existing practices may benefit from a number of improvements including, but not limited to, tailoring onboarding activities to entail more reflective discussion using small groups, especially for topics related to diversity and inclusion, revisiting areas where students may feel inadequately prepared to transition and perform well in a medical school, reevaluating administrative and financial support that can be roadblocks to a student's transition into the new environment and removing these barriers, and ensuring cultural coherence (organizational alignment of vision and mission) among faculty, staff, and upperclassmen. Future research directions include better understanding how developing single or multiple, identities can impact a medical students' experience with IP during onboarding, pre-clerkship, clerkship, or post-clerkship period, if at all.

Sleep quality and duration: A key to life satisfaction among military students.

Military service is a demanding profession that requires high physical preparedness and mental endurance. At the same time, the demands of military duties often require early rising and shortened sleep duration. Such a reduction in sleep can reduce physical and mental performance, and these changes can be reflected in life satisfaction. For this reason, soldiers' life satisfaction is a crucial variable for their success and long-term service. This study examined the relationship between sleep quality, sleep duration, and life satisfaction in military medical students. The results on 35 military students showed that greater sleep quality corresponded to greater life satisfaction; this relationship was moderate and significant (r = -460, p = .005). Notably, participants (n = 17) who began to wake up without the use of an alarm clock reported an average of 11% higher life satisfaction than the participants who woke to an alarm clock; this difference between participants was statistically significant (p = .011, Cohen's d = .911). Pre- and post-intervention showed that sleep hygiene education could be a suitable solution to prevent sleep deprivation and positively impact life satisfaction. Our findings emphasize the importance of increased sleep hygiene education, especially in preparing future military officers and during military exercises. Prioritizing sleep hygiene in these ways can significantly increase soldiers' life satisfaction.

Start-of-day oculomotor screening demonstrates the effects of fatigue and rest during a total immersion training program

BackgroundInvestigating changes in sleep and fatigue metrics during intensive surgical and trauma skills training, this study explored the dynamic association between oculomotor metrics and fatigue. Specifically, alterations in these relations over extended stress exposure, the influence of time of day, and the impact of fatigue exposure on sleep metrics were examined. MethodsThirty-nine military medical students participated in 6 days of immersion, hyper-realistic, and high-stress experiential casualty training. Participants completed surveys assessing the state of sleepiness with oculomotor tests performed each morning and evening, analyzing eye movement and pupillary change to characterize fatigue. Participants wore Fitbit TM devices to measure overall time asleep and time in each sleep stage during the training. ResultsFitbit data showed increased average minutes in rapid eye movement, deep sleep, and less time in light sleep from day 1 to day 4. The microsaccade peak velocity-to-displacement ratio exhibited a morning decrease but not in afternoon sessions, indicating repeated but temporary effects of accumulated fatigue. There were no findings regarding pupil reactivity to illumination changes. ConclusionThis study describes characteristics of fatigue measured by rapid and individually calibrated oculomotor tests. It demonstrates oculomotor relationships to fatigue in start-of-day testing, providing a direction for timing for optimal fatigue testing. These data suggest that improved sleep could signal resilience to fatigue during afternoon testing. Further investigation with more participants and longer duration is warranted. A deeper understanding of the interrelationships between training, sleep, and fatigue could improve surgical and military fitness.

Self-esteem, Self-efficacy, and Smoking Prevalence: A Cross-sectional Study Among Military and Civilian Medical Students

"Background: The prevalence of smoking among students is a growing concern, particularly among medical students. Being associated with stress, competitiveness, and various social influences, smoking can have detrimental effects on self-esteem and self-efficacy and may create a vicious cycle that may contribute to student’s well-being and academic performance outcomes. We aimed to investigate the relationship between self-esteem, self-efficacy, and smoking habits among medical students and their sociodemographic correlates. Methods: A cross-sectional study on 456 medical students was conducted via an online survey using structured questionnaires on socio-demographic characteristics, smoking habits, nicotine dependence, self-esteem, and self-efficacy. Results: The prevalence of smoking was 31.1% The scores of self-esteem and self-efficacy were positively correlated with smoking habits (W1=0.957, W2=0.975, P&lt;0.05). Students presented rather low smoking addiction with male students having slightly higher scores than female students on self-esteem and self-efficacy, military students had higher self-esteem scores than civilians with physical activity having a positive correlation with non-smoking behavior. Conclusion: According to our results, selfesteem and self-efficacy were slightly positively correlated with smoking habits. Furthermore, there was no statistically significant association between other social factors and smoking. Our results may develop a theoretical basis for medical students’ psychological variables studying for further implementation of university educational programs and preventive interventions empowering students towards an overall better quality of life, addressing, among others, smoking behaviors."

The effect of physical and psychological stress on the oral microbiome.

The oral microbiome is incredibly complex, containing a diverse complement of microbiota that has previously been categorized into 6 broad phyla. While techniques such as next-generation sequencing have contributed to a better understanding of the composition of the oral microbiome, the role it plays in human health and disease is still under investigation. Previous studies have identified that a more diverse microbiome is advantageous for health. Therefore, alterations to the physical or mental health that are of interest in this study, such as stress, are the factors that decrease microbial diversity, leading to the potential for dysbiosis and disease disposition. Intensive Surgical Skills Week (ISSW) is a hyper-realistic simulation training week for military medical students that takes place at the Strategic Operations (STOPS) facility in San Diego, CA. This training week puts students through mass causality simulations and requires them to work through distinct roles within the healthcare team, providing an almost ideal environment to assess the impact of acute stress on oral microbiome diversity. Based on the literature on stress and microbiota, we hypothesized that the high stress simulation events at ISSW will impact the composition and diversity of the oral microbiome. To investigate this hypothesis, thirty-seven (n = 37) second-or third-year medical students who are enlisted in a branch of the military and who attended ISSW in July of 2021 were included in the study. Student participants were divided into 7 teams to complete the hyper-realistic simulations (SIMs) at ISSW. A pilot of sixty-four buccal samples (n = 64) from three of the seven teams were sent for analysis at the University of Missouri Metagenomic Center. We saw an overall increase in species richness at the end of ISSW when looking at all samples (n = 64). Fourteen significantly different bacteria were identified from the beginning to the end of data collection. Additionally, third year medical students appear to have a greater species richness compared to second year medical students. Further, third year medical students had a statically significant difference in their oral microbiome richness from beginning to end of data collection (p = 0.008). Our preliminary data indicates that physical and psychological stress can impact the composition of the oral microbiome. The analyses in this study show that using the oral microbiome as an indicator of stress is promising and may provide evidence to support stress management practices.

Clinical and immunological characteristics of medical students depending on the duration and program of study

Chronic psycho-emotional stress can cause dysfunction of neuroimmunoendocrine dysregulation with consequences in the form of a violation of the functional potential of the immune system. Adaptation to new living conditions at the start of studies at a medical university is one of the inevitable circumstances that first-year students overcome. Education under the military training program at a medical university carries an additional stress load in this aspect. Research on the mechanisms of formation of adaptive reactions of the immune system during training under the military training program for officers of the medical service is of undoubted interest. The purpose of the study was to compare the clinical manifestations of immune-mediated pathology and the parameters of adaptive and innate immunity of medical students depending on the length of service and training program. Under observation were 104 medical students, all men, of which 37 were first-year students and 67 were third-year students of a medical university. The subjects of each course were divided into two subgroups depending on the training program. The group of first-year students consisted of 18 people from the military training center (VTC) and 19 people from the medical and preventive faculty (LPF). Among the third-year students of the VUC – 31, LPF – 36. For the clinical characterization of the incidence during the year of study, registration cards for the analysis of immune-mediated pathology were used, the parameters of the immune system at the end of the spring semester were studied using standard methodological approaches. The data obtained indicate that in the first year students with an additional load in the form of a military training program have a more difficult time adapting to learning in comparison with first-year students of the medical faculty. These differences consist in a more frequent and significant clinical manifestation of infectious pathology and are reflected in the functional potential of cellular parameters of innate immunity. The statement of signs of inhibition of the functional potencies of macrophage cells and natural killers in firstyear students of a military training center is an alarming factor in the possible disruption of the adaptive reserves of the immune response system, which probably suggests the need to develop programs to prevent the negative impact of stress-forming factors. By the third year of study, the students of the military training center have the best clinical and immunological indicators of the functioning of the immune system in comparison with the students of the standard educational program of general practitioners. It is likely that during this period the process of psychological adaptation of military medical students is completed.

Impact of a Multiday, High-fidelity, Immersive Simulation on Military Medical Students' Self-confidence.

Decision-making is a critical competence that all medical students must develop before becoming independently licensed physicians. One aspect of the decision-making process is confidence, which has not been extensively studied in undergraduate medical education. Intermittent simulation has been found to improve medical students' self-confidence across a wide range of clinical scenarios; however, no research to date has examined how a more extensive medical and operational simulation impacts miltary medical students' confidence in their decision-making abilities. This study was conducted online through the Uniformed Services University and in person at Operation Bushmaster, a multiday, out-of-hospital, high-fidelity, immersive simulation held at Fort Indiantown Gap, PA. This investigation focused on examining the impacts of asynchronous coursework and simulation-based learning on improving decision-making confidence for senior medical students 7 months before graduation. Thirty senior medical students volunteered. Each completed a 10-point confidence scale before and after either accomplishing asynchronous online coursework (control group) or attending a medical field practicum (experimental group). We conducted a repeated-measures analysis of variance to examine any change in students' confidence scores before and after completing each educational modality. The results of the analysis of variance indicated a significant time effect for our students' confidence in both the experimental and control groups as measured on our confidence scale, suggesting that Operation Bushmaster and asynchronous coursework both possessed the potential to increase students' confidence in their decision-making. Both simulation-based learning and asynchronous online learning can increase students' decision-making confidence. Future larger-scale research is needed to calculate the impact of each modality on military medical students' confidence.

The Impact of High-fidelity Simulations on Medical Student Readiness.

Simulation is a key aspect of the military unique curriculum at the Uniformed Services University (USU). The Department of Military and Emergency Medicine conducts rigorous high-fidelity simulations for military medical students during each year of their medical school training: Patient Experience (first year), Advanced Combat Medical Experience (second year), Operation Gunpowder (third year), and Operation Bushmaster (fourth year). There is currently a gap in the professional literature regarding students' progression through each of these simulations. This study, therefore, explores the experiences of military medical students at USU in order to understand how they learn and develop as they progress through these high-fidelity simulations. Using a grounded theory approach to qualitative research design, we analyzed qualitative data from 400 military medical students across all four years of military school who participated in the four high-fidelity simulations during 2021-2022. Our research team used open and axial coding to categorize the data and to make connections between each of these categories, which we articulated in a theoretical framework and illustrated in a consequential matrix. This research was approved by the Institutional Review Board at USU. During Patient Experience, the first-year medical students described the stress, chaos, and lack of resources that military physicians face as they experienced the realism of the operational environment. Later at Advanced Combat Medical Experience, the second-year medical students practiced their medical skills hands-on for the first time in the simulated stressful operational environment. As a result, they gained confidence and began to formulate their professional identity. Next, at Operation Gunpowder, the third-year medical students advanced to more complex tactical field care as they performed prolonged casualty care, forward resuscitative care, forward resuscitative surgical care, and en route care as a team, often revealing gaps in their knowledge that needed to be filled. During the capstone simulation, Operation Bushmaster, the fourth-year medical students closed these gaps and solidified their professional identity as leaders and physicians, culminating in a strong confidence regarding their readiness for their first deployment. Each of the four high-fidelity simulations impacted the students in unique ways as they were incrementally challenged to practice and build upon their knowledge, skills, and abilities related to combat casualty care, teamwork, and leadership in the operational environment. As they completed each of the simulations, their skills improved, confidence grew, and professional identity solidified. Therefore, completing these rigorous simulations progressively over the course of 4 years of medical school appears to be a vital process and foundation for the deployment readiness of early-career military physicians.

Interprofessional Experiences of Family Nurse Practitioner Students During a Military Field Practicum.

Team building is a real-world necessity in military and civilian health care settings. Interprofessional education (IPE) is therefore an essential component of health care education. At the Uniformed Services University, there are continued, deliberate attempts for IPE to occur to successfully prepare students to work together and adapt to ever-changing contexts. Although past quantitative research has analyzed interprofessional collaboration among military medical students, this study explores the interprofessional experiences of family nurse practitioner (FNP) students during a military medical field practicum. This study was reviewed by the Uniformed Services University Human Research Protections Program Office (Protocol DBS.2021.257). We used the qualitative transcendental phenomenological approach to design our study. We analyzed the reflection papers of 20 family nurse practitioner students who participated in Operation Bushmaster in order to explore their interprofessional experiences. Our research team coded and categorized the data, developing textural and structural descriptions of these categories, which served as the results of our study. We present the study's three key findings that students expressed and include perspectives from their viewpoints to illustrate each theme. The three themes related to IPE are (1) quality of integration determines perception of experience, (2) challenges inspire continued growth, and (3) increased self-awareness of one's own strengths. It is important for educators and leaders to find ways to allow for positive team integration and cohesion so that students do not feel overwhelmed by their perceived lack of knowledge or experience. Educators can use that perception to motivate a growth mindset so that they can continually seek out ways to improve and grow. Additionally, educators can prepare students with adequate knowledge to ensure that each team member meets mission success. Finally, to continually develop, students need to have awareness of their own strengths as well as areas for growth to enhance their own performance as well as that of the military interprofessional health care teams.

"Not for the Faint of Heart": First-year Military Medical Students' Professional Identity Formation During the Innovative Patient Experience at Operation Bushmaster.

The role of a military medical officer (MMO) is complex. Therefore, it is essential that military medical students formulate their professional identity early on in medical school in order to prepare them for their first deployment. At the Uniformed Services University, students are challenged to progressively develop their professional identity through yearly high-fidelity military medical field practicums (MFPs). One of these MFPs, Operation Bushmaster, consists of an innovative "Patient Experience" in which first-year medical students portray patients cared for by fourth-year medical students in a simulated operational environment. The purpose of this qualitative study was to examine how participating in the Patient Experience impacted first-year medical students' professional identity formation. Our research team used a phenomenological, qualitative research design to analyze the end-of-course reflection papers of 175 first-year military medical students who participated in the Patient Experience during Operation Bushmaster. Our research team members individually coded each student's reflection paper and then came to consensus on how to organize these codes into themes and subthemes. Two themes and seven subthemes emerged from the data regarding the first-year medical students' understanding of the MMO: (1) multiple roles of the MMO (educator, leader, diplomat, and advisor) and (2) role of the MMO in the operational environment (navigates hazardous environment, adaptability, and position within health care team). As they participated in the Patient Experience, the first-year medical students not only recognized the complexity of the MMO's multiple roles within the operational environment but also envisioned themselves in these roles. The Patient Experience provided first-year medical students with a unique opportunity to formulate their professional identity as they portrayed patients during Operation Bushmaster. This study's results hold implications for both military and civilian medical schools regarding the benefits of innovative military MFPs for professional identity formation in junior medical students, preparing them early on in medical school for their first deployment.

Students' Leadership Development During a High-fidelity Military Medical Field Practicum.

Leadership development is a cornerstone aspect of military medical education. Operation Bushmaster, a medical field practicum (MFP) conducted by the USU, tests fourth-year medical students' clinical skills and leadership acumen in an operational environment. No studies have examined students' perceptions of their own leadership development during this MFP. Therefore, this study explored leadership development from the students' perspectives. Using a qualitative phenomenological design, we analyzed the reflection papers of 166 military medical students who participated in Operation Bushmaster during the fall of 2021. Our research team coded and categorized the data. Once defined, these categories served as the themes in this study. Three central themes were expressed: (1) the importance of direct and decisive communication, (2) unit cohesion and interpersonal relationships enhance the team's ability to adapt, and (3) followership quality determines leadership outcomes. The students' leadership ability was maximized by established relationships within their unit and well-practiced communication, and a decreased propensity for followership negatively affected leadership. Overall, Operation Bushmaster increased students' appreciation of the importance of leadership development and overall enhanced their leadership outlook as a future military medical officer. This study provided an introspective vantage from military medical students pertaining to their own leadership development, as participants described how the challenging environment of a military MFP challenged them to hone and develop their leadership skills. As a result, the participants gained a greater appreciation of continued leadership development and realization of their future roles and responsibilities within the military health care system.

Military Medical Students’ Coping With Stress to Maintain Well-being

ABSTRACT Introduction Previous studies have shown that medical students experience a great level of burnout and poor well-being during their clinical training periods. In this study, we sought to understand how military medical students cope with stress to prevent burnout and support their well-being. We also investigated if these coping strategies are associated with military medical students’ self-reported well-being, burnout, and depression levels. The findings could help inform programming, resources, and educational strategies to better support students to thrive in their careers long term. Methods Using a cross-sectional research design, we surveyed military medical students and conducted content analysis on participant responses to the open-ended item by trained coders. Coding was based on the existing coping theory frameworks as well as categories that emerged inductively to represent the data. Results The primary four strategies military medical students utilized included social connection (59.9%), exercise (58.3%), personal relaxation (36%), and work–life balance (15.7%). The use of work–life balance strategy was significantly associated with more positive well-being and lower depression compared to those who did not use this strategy. Three main coping typologies were further extracted, including personal care, connection, and cognitive strategies. Based on the typologies, 62% of students were recognized as multi-type copers (who combined more than two coping typologies), who reported significantly more positive well-being compared to students who relied on a single typology. Conclusions The findings demonstrate that certain coping strategies are more positively associated with a good state of well-being and less burnout, and that utilization of multiple types of coping strategies is more supportive. This study amplifies the voice of military medical students concerning the importance of prioritizing self-care and available resources given the unique pressures and demands of their dual military medical curriculum.