Military Pediatricians Research Articles

Conceptualizing and Developing Competence in Newborn Medicine Among Military Pediatricians.

Competence in neonatal care is especially important for military pediatricians because military pediatricians can be asked to serve in remote duty locations with limited resources. We sought to understand how this competence is defined, developed, and assessed by military pediatric training programs. After Institutional Review Board approval was obtained, we interviewed educators and recent graduates from every pediatric military training program to construct a shared definition of competence. We then used Kern's Six Steps for curriculum development to understand how competence is taught and assessed. Participants felt that competence for military pediatricians in the neonatal setting meant that learners should be able to provide a full spectrum of newborn care in any military setting. Participants confirmed that this competence was particularly important for military pediatricians because of the possibility of remote duty locations. Participants felt that specific knowledge, skills, and attitudes supported competence. Knowledge domains include distinguishing normal newborns from abnormal newborns, managing normal newborn care, managing common newborn abnormalities, and creating a safe escalation plan for complicated or uncommon newborn abnormalities. Specific skills that support competence are newborn resuscitation, delivery of effective ventilation, and neonatal circumcision. Specific attitudes that support competence are, understanding the personal limits of knowledge and understanding the resources for escalation of care. Educators use a variety of modalities to teach toward competence, including the structured curricula, bedside teaching, and simulation. According to participants, the assessment of learners occurs primarily through narrative assessment and feedback but would ideally occur through direct observation. Competence in the neonatal setting is particularly important for military pediatricians. Essential skills undergo differential assessment and current assessment methods differ from ideal assessment methods. Future work should focus on how these facets can support a unified curriculum in newborn medicine.

The Impact of Military Pediatrics: Assessing Clinical, Leadership, Academic, and Operational Experience Among Pediatric-trained Graduates From the Uniformed Services University of the Health Sciences (USU).

This article uses alumni survey data from the Uniformed Services University of the Health Sciences (USU) F. Edward Hébert School of Medicine to assess the professional impact of pediatric-trained USU graduates over the course of their careers. We specifically report on the clinical and leadership roles held, career accomplishments, and operational involvement among military pediatricians. This study analyzed survey data that were collected from alumni of USU. We used descriptive statistics to report the career achievements and operational experiences among USU graduates who completed training in pediatrics. This study was deemed exempt by the USU Institutional Review Board. The survey response rate was 49.5% among 2,400 eligible respondents. Out of 1,189 alumni respondents, 110 (9.3%) trained in pediatrics. Among the pediatric-trained USU graduates, 98.2% spent some time as a full-time clinician, 73.6% served as chief of a clinical service, 42.7% held the role of department chair/chief or the equivalent, and 26.3% filled leadership positions in deployed settings. Forty percent of USU-trained military pediatricians deployed to combat areas at least once, and 35.5% participated in at least one peacetime humanitarian mission. Our findings contribute to the unique story of military pediatricians who graduated from USU. These uniformed pediatricians participate actively in all realms of military medicine and have demonstrated their versatility through participation in a wide variety of vital functions. Their contributions include the provision of clinical care for both military children and active duty service members, serving in varied leadership positions, engaging in health professions education and other academic pursuits, and participating in operational assignments. Future studies could aim to more fully address the diverse contributions of military pediatricians to the overall mission by including more specific data about career experiences from all uniformed pediatricians.

Health and Mental Health Needs of Children in US Military Families.

Children in US military families share common experiences and unique challenges, including parental deployment and frequent relocation. Although some of the stressors of military life have been associated with higher rates of mental health disorders and increased health care use among family members, there are various factors and interventions that have been found to promote resilience. Military children often live on or near military installations, where they may attend Department of Defense-sponsored child care programs and schools and receive medical care through military treatment facilities. However, many families live in remote communities without access to these services. Because of this wide geographic distribution, military children are cared for in both military and civilian medical practices. This clinical report provides a background to military culture and offers practical guidance to assist civilian and military pediatricians caring for military children.

USU's Pediatric Interest Group: Preparing the Next Generation of Military Pediatricians.

USU's Pediatric Interest Group: Preparing the Next Generation of Military Pediatricians.

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.

Health and Mental Health Needs of Children in US Military Families

The wars in Afghanistan and Iraq have been challenging for US uniformed service families and their children. Almost 60% of US service members have family responsibilities. Approximately 2.3 million active duty, National Guard, and Reserve service members have been deployed since the beginning of the wars in Afghanistan and Iraq (2001 and 2003, respectively), and almost half have deployed more than once, some for up to 18 months' duration. Up to 2 million US children have been exposed to a wartime deployment of a loved one in the past 10 years. Many service members have returned from combat deployments with symptoms of posttraumatic stress disorder, depression, anxiety, substance abuse, and traumatic brain injury. The mental health and well-being of spouses, significant others, children (and their friends), and extended family members of deployed service members continues to be significantly challenged by the experiences of wartime deployment as well as by combat mortality and morbidity. The medical system of the Department of Defense provides health and mental health services for active duty service members and their families as well as activated National Guard and Reserve service members and their families. In addition to military pediatricians and civilian pediatricians employed by military treatment facilities, nonmilitary general pediatricians care for >50% of children and family members before, during, and after wartime deployments. This clinical report is for all pediatricians, both active duty and civilian, to aid in caring for children whose loved ones have been, are, or will be deployed.

Military Children, Families, and Communities: Supporting Those Who Serve

* Abbreviations: AAP — : American Academy of Pediatrics DoD — : Departent of Defense SOUS — : Section on Uniformed Services WWII — : World War II More than 2 million children in the United States live in military families and 90 000 infants are born to these families each year. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents , third edition,1 a publication of the American Academy of Pediatrics (AAP), outlines an approach to comprehensive care for the individual child in the context of his or her family, as well as the community. Understanding the unique concerns of military families, such as the stress of parental wartime separation, and the specific resources available to these families, can help prepare all pediatric providers to meet the needs of this population regardless of where a medical home is established. Although military pediatricians are subject matter experts on military children and family needs, military pediatricians are not the sole providers of care for military children. Up to 50% of children in military families obtain their primary care outside of a military medical facility.2 Some service members’ families leave military installations and return “home” during deployment and obtain local pediatric care. National Guard and Reserve members often use established local resources, rather than switch to active-duty services during their “activation.” The Department of Defense (DoD) direct health care system is not large enough to care for all military children. Therefore, all pediatricians should be familiar with the population of American children who live in military families. A review of the historical perspective and the current demographics of the US military family is helpful when framing the challenges faced by military children and those who care for them. Military and civilian pediatricians are better prepared to articulate the concerns of military children and support their needs if they understand the child within the context of his or her family and community. For most of its history, the … Address correspondence to Beth Ellen Davis MD MPH, Department of Pediatrics, Madigan Army Medical Center, Tacoma WA 98431. E-mail: bedavis{at}uw.edu

Pediatric Infectious Diseases: 60 Years of Contributions by Military Pediatricians

* Abbreviations: AAP — : American Academy of Pediatrics CSD — : cat-scratch disease ETEC — : enterotoxigenic Escherichia coli NAMRU-3 — : Naval Medical Research Unit 3 RSV — : respiratory syncytial virus USUHS — : Uniformed Services University of the Health Sciences To describe the many contributions that uniformed pediatricians have made to the field of pediatric infectious diseases is a complicated task. Part of the difficulty is that for the decades after the end of World War II, a number of talented and brilliant physicians spent short periods of time in the military to fulfill their service obligations. Investigators such as Floyd Denny and Lew Wannamaker published their seminal works on group A β-hemolytic streptococci and rheumatic fever while on active duty in the US Air Force.1 Some of the early work on vaccines for common childhood infections was done by investigators who, at least for a portion of time, wore a military uniform. In addition, many of the contributions of military physicians were often made alongside and in concert with their civilian colleagues. In an attempt to illustrate some of the more significant contributions of military pediatricians to the field of pediatric infectious disease, however, a good starting point would be the work of Colonel Ogden Bruton. His early work performed over 60 years ago in many ways began the military legacy of clinical research in a variety of important areas of pediatric infectious disease but in particular those areas where the disciplines of clinical immunology and infectious disease have overlapped. While evaluating children at what was then known as Walter Reed General Hospital in 1951, Colonel Ogden Bruton observed an 8-year-old boy with recurrent pneumonia. Dr Bruton noted the unusual pattern of this child’s pneumonias, and while analyzing the child’s immune system, noted a lack of serum immunoglobulin. Dr Bruton’s observations eventually led to his reporting of the first primary immunodeficiency disease ever to be described, Bruton’s agammaglobulinemia. Both Dr Bruton’s discovery of the disease as well as his attempts at treating it with specific immunotherapy in the … Address correspondence to Michael Rajnik, MD, Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814. E-mail: mrajnik{at}usuhs.mil

American Pediatricians at War: A Legacy of Service

* Abbreviations: AAP — : American Academy of Pediatrics MASH — : Mobile Army Surgical Hospital MEDCAP — : Medical Civic Action Program MILPHAP — : Military Provincial Hospital Assistance Program USARV — : US Army Vietnam USNR — : United States Naval Reserve American pediatricians have gone to war for almost as long as pediatrics has been a specialty. A decade after Jacobi, Osler, and Forchheimer founded the American Pediatric Society in 1888, pediatricians, or “pediatrists” as they were sometimes called, were serving with the American military on foreign soil. Across more than a century of service, the role of pediatricians in armed conflict has often been unclear to military and civilian leaders, fellow physicians, and at times even to members of their own specialty. In a 2003 site inspection of an overseas US military treatment facility, the assistant secretary of defense for health affairs was briefed about pediatricians. “Why would we need pediatricians here?” was his reply. Despite the confusion, every major conflict since the Spanish–American War has witnessed American military pediatricians serving in a variety of roles. From Cuba to Kandahar, the beaches of Normandy to Mosul, the century of service continues around the globe and forms the fabric of the story of America’s uniformed pediatricians today.1–3 At the close of the 19th century, pediatricians played a very different role than in today’s society. Pediatricians were considered specialists rather than primary care providers for children. There were very few pediatricians in America, and they mostly served in large academic centers or in urban hospitals. Because accurate records of medical specialists were not routinely kept at the time of the Spanish–American War, it is unclear how many pediatricians served in the US military during that conflict. Samuel Walter Kelley was one famous pediatrician whose record of service is known. Dr Kelley spent most of his adult life in Cleveland, where he was a professor of diseases of children in the Cleveland College of Physicians and Surgeons. He worked in Cleveland as both a pediatrist and a pediatric surgeon. He … Address correspondence to LTC Mark W. Burnett, Task Force Raider, 6th Squadron, 4th Cavalry Regiment, Combat Outpost Keating, Nuristan Province, Afghanistan. E-mail: mark.w.burnett{at}us.army.mil

Barriers to Vitamin D Supplementation Among Military Physicians

We surveyed military pediatricians and family physicians about barriers to vitamin D supplementation. We obtained lists of uniformed members of the American Academy of Pediatrics (AAP) and American Academy of Family Practice (AAFP). Three hundred individuals were randomly selected from each group and surveyed about: (1) practice habits; (2) vitamin D use and barriers to supplementation; (3) demographic factors. Pediatricians were 40% more likely to be aware of AAP recommendations about vitamin D (p < 0.001) and 40% more likely to prescribe vitamin D to exclusively breastfed infants (p < 0.001). The most common reason for not recommending vitamin D was the belief that breastfed infants received adequate sunlight. Most military pediatricians supplement breastfed infants with vitamin D. Military family physicians are less likely to supplement breastfed infants and are targets for educational interventions. Many physicians mistakenly believe that adequate sunlight exposure prevents vitamin D deficiency, another focus for future interventions.

History of U.S. Military Contributions to the Study of Respiratory Infections

History reveals a tremendous impact of respiratory pathogens on the U.S. military, dating back to the time of the Revolutionary and Civil Wars, during which 90% of casualties were for nonbattle injury, including several respiratory illnesses such as measles, whooping cough, and complicated pneumonia. The devastating impact of the influenza pandemic at the end of World War I led to a more proactive approach to research into the etiologies and potential preventive measures for such diseases. The development of the Armed Forces Epidemiological Board, with its subordinate commissions, coincided with the massive mobilization for World War II. Efforts of the board during and after the war led to significant progress against many common pathogens, such as the landmark studies of group A Streptococcus among young trainees at Warren Air Force Base, which led to the development of highly effective prophylactic and therapeutic strategies to prevent rheumatic fever. Military pediatricians contributed greatly to this work, as well as subsequent investigations into both the pathogenesis of and prophylactic therapy for a variety respiratory pathogens, including pertussis and respiratory syncytial virus. The momentum of this work continues to this day, among researchers from all three military branches.

The Pediatric Critical Care Experience at Naval Hospital Guam: Suggestions for Critical Care Training during Residency

To determine the critical care experience encountered by three recently graduated military pediatricians at an overseas military hospital and present one model of maximizing allowable critical care training time during residency. Retrospective reviews of all admissions to the special care nursery and intensive care unit at U.S. Naval Hospital Guam were performed for a 3-year and a 2-year period, respectively. Age, diagnosis, birth weight (if applicable), level of nursery care, invasive procedures performed in the nursery (endotracheal tube, umbilical artery, and umbilical venous catheter placement), patient outcome, and the need for medical transport were recorded. During a 3-year period, there were 122 admissions to the special care nursery (7.1% of all deliveries). In addition, pediatricians performed a total of 53 invasive procedures on these patients, and 29 infants required medical transport to an off-island neonatal intensive care unit for additional care. During a 2-year period, 70 pediatric patients were admitted to the adult intensive care unit, representing 10.2% of all intensive care unit admissions during this period. Fourteen of these patients required medical transport to an off-island referral hospital. Graduating military pediatric residents may be faced with caring for a wide range of critically ill neonatal and pediatric patients depending on their assignment. Residency training programs, with the recent increased emphasis on primary pediatric care, will need to streamline instruction in pediatric critical care to provide maximal benefit to the resident while maintaining compliance with Residency Review Committee guidelines.